Pattern of Ipsilateral Breast Tumor Recurrence After Breast-Conserving Therapy

The rate of ipsilateral breast tumor recurrence (IBTR) in breast cancer after breast-conserving therapy was analyzed. We demonstrate that after 12 years' follow-up, there is an especially high recurrence rate for women ≤40 years old. For women ≤40 years old, the absence of adjuvant systemic therapy and the presence of lymph vascular space invasion (LVSI) are associated with a higher rate of IBTR. For women >40 years old, the presence of LVSI and lobular carcinoma in situ are prognostic factors for IBTR

Parenthood in survivors of Hodgkin lymphoma: an EORTC-GELA general population case-control study.

Contains fulltext : 108966.pdf (publisher's version ) (Open Access)PURPOSE: We investigated the impact of Hodgkin lymphoma (HL) on parenthood, including factors influencing parenthood probability, by comparing long-term HL survivors with matched general population controls. PATIENTS AND METHODS: A Life Situation Questionnaire was sent to 3,604 survivors treated from 1964 to 2004 in successive clinical trials. Responders were matched with controls (1:3 or 4) for sex, country, education, and year of birth (10-year groups). Controls were given an artificial date of start of treatment equal to that of their matched case. The main end point was presence of biologic children after treatment, which was evaluated by using conditional logistic regression analysis. Logistic regression analysis was used to analyze factors influencing spontaneous post-treatment parenthood. RESULTS: In all, 1,654 French and Dutch survivors were matched with 6,414 controls. Median follow-up was 14 years (range, 5 to 44 years). After treatment, the odds ratio (OR) for having children was 0.77 (95% CI, 0.68 to 0.87; P < .001) for survivors compared with controls. Of 898 survivors who were childless before treatment, 46.7% achieved post-treatment parenthood compared with 49.3% of 3,196 childless controls (OR, 0.87; P = .08). Among 756 survivors with children before treatment, 12.4% became parents after HL treatment compared with 22.2% of 3,218 controls with children before treatment (OR, 0.49; P < .001). Treatment with alkylating agents, second-line therapy, and age older than 35 years at treatment appeared to reduce the chances of spontaneous post-treatment parenthood. CONCLUSION: Survivors of HL had slightly but significantly fewer children after treatment than matched general population controls. The difference concerned only survivors who had children before treatment and appears to have more personal than biologic reasons. The chance of successful post-treatment parenthood was 76%

Capturing the luminous environment in hospital rooms: An overview of occupant–centered methods to inform design practice

Hospitals are complex environments having to balance out contradictory requirements from patients and health workers. Despite evidence demonstrating the critical role of the hospital’s luminous environment in responding to occupants’ requirements and needs, and the importance of engaging with the patient experience to improve the quality of patient care, to date, no studieshave articulated approaches to study conflicting occupants’ needs for lighting in context. This paper presents a semi–systematic literature review of disciplinary approaches to investigate quality lighting conditions in hospitals and subjective impressions of occupants. Research articles from the clinical, built environment, and lighting fields were selected and evaluated. The review outlined appropriate physical (i.e., photometric) and self-report (e.g., preferences) approaches for data collection in context and potential articulations between them. Mixed data collection and data analysis techniques are deemed essential to articulate lighting design strategies engaging with the requirements of hospital occupants on a 24-hour basis

The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Mental Health Financial Requirements among Commercial “Carve-In” Plans

Objective: Did mental health cost-sharing decrease following implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA)? Data source: Specialty mental health copayments, coinsurance, and deductibles, 2008-2013, were obtained from benefits databases for “carve-in” plans from a national commercial managed behavioral health organization. Study design: Bivariate and regression-adjusted analyses compare the probability of use and (conditional) level of cost-sharing pre-and post-parity. An interaction term is addedt o compare differential levels of pre-and post-parity cost-sharing changes for plans that were and were not already at parity pre-MHPAEA. Findings: Controlling for employer/plan characteristics, MHPAEA is associated with higher intermediate care copayments ($15.9) but lower outpatient ($2.6) copayments among in-network-only plans. Among plans with in-and out-of-network benefits, MHPAEA is associated with lower inpatient ($23.2)and outpatient ($2.5) copayments, but increases in inpatient and intermediate in-network and out-of-network coinsurance (about 1 percentage point). Among the few plans not at parity pre-MHPAEA, changes in use and level of cost-sharing associated with MHPAEA were more dramatic. Conclusion: Mixed evidence that MHPAEA led to more generous mental health benefits may stem from the finding that many plans were already at parity pre-MHPAEA. Future policy focus in mental health may shift to slowing growth in cost-sharing for all health services

The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Specialty Behavioral Health Care Utilization and Spending Among Carve-In Enrollees

OBJECTIVE The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA's impact on BH expenditures and utilization among "carve-in" enrollees. METHODS We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008-2009), during (2010), and after (2011-2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits, medication management, individual and family psychotherapy); intermediate care utilization (structured outpatient, day treatment, residential); and inpatient utilization. RESULTS MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits [respective immediate increases of: $1.05 (P=0.02);$0.88 (P=0.04); 0.00045 visits (P=0.00)], and individual psychotherapy visits [immediate increase of 0.00578 visits (P=0.00) and additional increases of 0.00017 visits/mo (P=0.03)]. CONCLUSIONS MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; for example, in July 2012 predicted per-enrollee plan spending was $4.92 without MHPAEA and$6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act's inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among “carve-out” enrollees

Interrupted time series with and without controls was used to evaluate whether the federal Mental Health Parity and Addiction Equity Act (MHPAEA) and its Interim Final Rule increased the probability of specialty behavioral health treatment and levels of utilization and expenditures among patients receiving treatment. Linked insurance claims, eligibility, plan and employer data from 2008 to 2013 were used to estimate segmented regression analyses, allowing for level and slope changes during the transition (2010) and post-MHPAEA (2011-2013) periods. The sample included 1,812,541 individuals ages 27-64 (49,968,367 person-months) in 10,010 Optum "carve-out" plans. Two-part regression models with Generalized Estimating Equations were used to estimate expenditures by payer and outpatient, intermediate and inpatient service use. We found little evidence that MHPAEA increased utilization significantly, but somewhat more robust evidence that costs shifted from patients to plans. Thus the primary impact of MHPAEA among carve-out enrollees may have been a reduction in patient financial burden

Long-term effects of first degree family history of breast cancer in young women: Recurrences and bilateral breast cancer

Background. The aim of this study is to analyze the impact of first degree relative (FDR) of young breast cancer patients. Methods. Data were used from our prospective population-based cohort study which started in 1983. The family history (FH) was registered with regard to FDR: the presence or absence of invasive breast cancer in none vs. one or more FDRs at any age. Results. A total of 1109 women, ≤50 years with 1128 breast conserving treatments was seen. The incidence of FDR was 17.0% for one FDR and 3.2% ≥2 FDR. The three groups, none, 1 or ≥2 FDR, were comparable. The local failure rate is comparable for all three groups. Women with a positive FH and metachronous bilateral breast cancer (MBBC) showed a lower local failure (HR 0.2; 95% CI 0.05–0.8). A positive FH was an independent predictor for a better disease-specific survival (HR 0.6; 95% CI 0.4–0.9). Conclusion. A positive FH, based on FDR implies a better prognosis in relation to survival for young women treated with BCT. In contrast to no FH for FDR, MBBC in women with a positive FH was not associated with an increased risk of local recurrenc

Occupant-centered approach to assessing lighting conditions in hospital patient rooms

Understanding how different people experience lighting is crucial to designing dynamic environments that meet user requirements for performance and well-being. Most studies performed in hospitals about occupant-centred responses to light have been conducted in workspaces and offices, with little attention given to patient rooms. Hospital lighting conditions are typically assessed using illuminance levels measured at floor or desk level; this metric only focuses on enabling occupants to move safely and perform desk-based tasks. Nurses (excluding ICU nurses) are often on the move and about 47% of their tasks are conducted in patient rooms. Patients, meanwhile, spend much of their recovery period lying on the bed, subjecting them to visual discomfort and circadian disruption (due to ceiling-mounted electric lighting and limited access to natural light). Patient rooms require more comprehensive lighting assessment procedures to ensure the lighting can accommodate the varying needs of users (patients, family members and staff).This exploratory study presents preliminary findings about various techniques and instruments for collecting environmental lighting data from the user’s perspective. The ICU simulation bay of a Brisbane tertiary hospital was the setting for this pilot study, with four lighting conditions measured from the perspectives of a 1) patient lying on a bed, and 2) a nurse standing next to the bed. Lighting metrics collected included melanopic and photopic illuminances, luminance distribution, and spectral data. Design interaction techniques (i.e., movement map) were also used to refine the instrument’s positions. The study outcomes are alternative procedures to capture naturalistic field data, which will inform the development of lighting strategies that respond to user requirements.<br/